Travel Health Evidence

Article

Malaria prevention for travellers: how the guidance works

Malaria prevention is the clearest case in travel medicine where generic advice fails. The right approach depends on where you are going, when and for how long, and national guidelines are built around exactly those variables.

Updated 2 min read 11 citations

Historic bed in a museum cottage with a net canopy hung above it
Infrogmation of New Orleans · CC BY-SA 3.0 · Wikimedia Commons

Why the destination decides

Malaria risk varies by country, by region within a country, by season, and by the type of trip. Parasite resistance to particular drugs also differs between regions, so a tablet that is appropriate for one destination may not be for another. Guidance is therefore built around destination risk rather than a single universal recommendation, and it is revised as resistance patterns change.

Examples of national guidance in this site's reference library show that structure: Italian guidelines for malaria prophylaxis in travellers to endemic areas [6], and earlier UK guidelines on preventing malaria in travellers from the United Kingdom, produced by the PHLS Malaria Reference Laboratory and the London School of Hygiene and Tropical Medicine [10]. Older guidance is useful for understanding the approach, not as a source for today's drug choice.

The wider pre-travel consultation

Recommendations for the practice of travel medicine place malaria within a broader pre-travel assessment, alongside vaccinations and other destination risks [8]. That is the format a travel clinic follows: itinerary first, then the measures that fit it.

Fever after you get home

Malaria can show up after a traveller returns, sometimes weeks later. Practice guidelines for evaluating fever in returning travellers and migrants exist for that reason [9], and UK guidelines cover the investigation of eosinophilia, a raised count of a type of white blood cell, in returning travellers [11]. The practical message is simple: a fever after visiting a malaria area needs prompt medical assessment, and you should say where you have been.

The four parts of prevention

StepWhat it involves
Risk assessmentDestination, season, length of stay and type of trip
ChemoprophylaxisA drug chosen for the destination under current national guidance
Bite preventionRepellent, nets and covering up, alongside any tablets
After returnPrompt assessment of any fever, mentioning recent travel

A worked example

A traveller plans to use leftover antimalarial tablets prescribed for a friend's trip to a different country two years ago. Because recommended drugs depend on destination and change over time, those tablets may not be appropriate. A pre-travel consultation using current guidance is the safe route.

Common questions

Is there one best antimalarial?
No. Guidance selects drugs by destination and individual factors.
Do I need repellent if I take tablets?
Yes. Bite prevention is part of the guidance alongside chemoprophylaxis, not an alternative to it.
What if I get a fever after coming home?
Seek medical assessment promptly and mention your travel. Guidelines for fever in returning travellers exist because this cannot wait.
Does this replace a travel clinic?
No. This page explains how the guidance works; a clinician applies it to your itinerary and health.
Vaccine vial next to a sachet of bicarbonate buffer to be mixed before drinking
Dvermeirre · CC BY-SA 4.0 · Wikimedia Commons
The evidence behind this page A stacked bar showing the composition of the 11 publications cited on this page by study type. 101meta-analysis (10)review (1)
11 publications, 1997–2026. This is a largely observational base. It can establish that things occur together; it cannot settle which one causes the other. Source: this page’s own citation list, below.

References

Every citation below links to the original peer-reviewed record on PubMed or via DOI. Nothing here is a substitute for medical advice.

  1. 2026 Swiss Society for Infectious Diseases recommendations for Clostridioides difficile infection Guery B, Albrich WC, Brugger SD, et al. · Swiss medical weekly · 2026 · Clinical guideline DOIPubMed 42781732
  2. Diagnosis, management and prevention of loiasis: guideline of the German Society for Tropical Medicine, Travel Medicine, and Global Health (DTG) Ramharter M, Schlabe S, Hübner MP, et al. · Infection · 2025 · Clinical guideline DOIPubMed 40397272Full text
  3. Management of Invasive Pulmonary Aspergillosis in Intensive Care Units: Guidelines From the Fungal Infection Network of Switzerland (FUNGINOS) Lamoth F, Albrich WC, Ragozzino S, et al. · Mycoses · 2025 · Clinical guideline DOIPubMed 41311305Full text
  4. Executive Summary of the Spanish Guidelines for the Diagnosis and Management of Imported Febrile Illnesses from the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Imported Pathology Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEPI-SEIMC), the Spanish Society of Family and Community Medicine (SEMFYC), the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Society of Emergency Medicine (SEMES) Camprubí-Ferrer D, Díaz Menendez M, Crespillo-Andújar C, et al. · Enfermedades infecciosas y microbiologia clinica (English ed.) · 2024 · Systematic review DOIPubMed 38965027
  5. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) Galiè N, Humbert M, Vachiery JL, et al. · European heart journal · 2016 · Clinical guideline DOIPubMed 26320113
  6. New Italian guidelines for malaria prophylaxis in travellers to endemic areas Calleri G, Castelli F, El Hamad I, et al. · Infection · 2014 · Clinical guideline DOIPubMed 24347205
  7. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations Josephs LK, Coker RK, Thomas M · Primary care respiratory journal : journal of the General Practice Airways Group · 2013 · Clinical guideline DOIPubMed 23732637Full text
  8. Recommendations for the practice of travel medicine Chiodini JH, Anderson E, Driver C, et al. · Travel medicine and infectious disease · 2012 · Clinical guideline DOIPubMed 22658381
  9. Practice guidelines for evaluation of Fever in returning travelers and migrants D'Acremont V, Ambresin AE, Burnand B, et al. · Journal of travel medicine · 2003 · Clinical guideline DOIPubMed 12740187
  10. Guidelines for the prevention of malaria in travellers from the United Kingdom. PHLS Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine Bradley DJ, Warhurst DC · Communicable disease report. CDR review · 1997 · Clinical guideline PubMed 9376899
  11. UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants Thakker C, Warrell C, Barrett J, et al. · The Journal of infection · 2025 · Review DOIPubMed 39537036